Long-term prognosis of subclinical sensitization with diphenylcyclopropenone in patients with alopecia areata

Abstract

To the Editor: Contact immunotherapy is widely used in the treatment of severe alopecia areata (AA). 1 Meah N. Wall D. York K. et al. The alopecia areata consensus of experts (ACE) study: results of an international expert opinion on treatments for alopecia areata. J Am Acad Dermatol. 2020; 83: 123-130 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar However, due to varied treatment response to contact immunotherapy, predicting the prognosis of AA is challenging. 2 Lamb R.C. Young D. Holmes S. Retrospective review of diphencyprone in the treatment of alopecia areata. Clin Exp Dermatol. 2016; 41: 352-358 Crossref Scopus (20) Google Scholar A systematic review of contact immunotherapy reported a recurrence rate of 49% in the absence of maintenance treatment. 3 Lee S. Kim B.J. Lee Y.B. et al. Hair regrowth outcomes of contact immunotherapy for patients with alopecia areata: a systematic review and meta-analysis. JAMA Dermatol. 2018; 154: 1145-1151 Crossref PubMed Scopus (46) Google Scholar However, there were no results for long-term prognosis. The modified diphenylcyclopropenone (DPCP) treatment protocol, characterized by subclinical sensitization, has a therapeutic efficacy as favorable as that of the standard protocol, with fewer side effects. 4 Choe S.J. Lee S. Pi L.Q. et al. Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata: retrospective analysis of 159 cases. J Am Acad Dermatol. 2018; 78: 515-521.e4 Abstract Full Text Full Text PDF Scopus (10) Google Scholar In a previous study conducted at our institution in 2017, 46 of 159 patients who underwent the modified DPCP treatment protocol showed complete response (CR). After a 2-year follow-up of patients who achieved CR during that time, 20 experienced recurrence. 4 Choe S.J. Lee S. Pi L.Q. et al. Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata: retrospective analysis of 159 cases. J Am Acad Dermatol. 2018; 78: 515-521.e4 Abstract Full Text Full Text PDF Scopus (10) Google Scholar The purpose of this study was to examine the long-term prognosis and related factors by confirming the recurrence of AA in the remaining 26 patients with CR.